Patient Education Wrap-up

1. Patient Education Wrap-up Nancy B. Clark, M.Ed. Doctoring 202 Spring 2014

2. Thanks • Curt Stine for his patient education slides and suggestions. • Kendall Campbell • Alice Pomidor

3. Objectives • COMPETENCY: Counsel and educate patients and their families (Patient Care) • Assess a patient’s health literacy: understanding of instructions, explanations of health problems, risk, treatment options, and ability to perform skills (i.e. self-injections, use of nebulizers, use of blood glucose monitor) • Provide effective one-on-one instruction to educate a patient. • Document patient education activities.

4. Objectives • COMPETENCY: Use information technology to support patient education (Patient Care) • Use appropriate applications at the point of care to supplement verbal instructions. • Assess a patient’s access to and ability to find and use technology to gain health information. • Select appropriate methods/materials to further educate the patient: handouts, models, videos, web sites, mobile apps, social media, support groups.

5. Definition • “Patient education can be defined as the process of influencing patient behavior and producing the changes in knowledge, attitudes and skills necessary to maintain or improve health (AAFP Reprint No 284).” • The outcome of effective patient education is a change in the patient—his/her behaviors, knowledge, attitudes and skills and reduction in anxiety and improved disease outcomes.

6. Promotion of Self-Care “A central aspect of the Chronic Care Model is to Empower and prepare patients to manage their health and health care. Patient education is central tothis concept.”

7. Preparation for Class • Watch: "Health literacy and patient safety: Help patients understand" • Watch: “House MD - Do I Look Like An Idiot?” • Watch “Achieving Adherence in Chronic Disease Management Part 2.”

8. Face-to-Face Patient Education

9. Stages of the Pt Ed Process • Diagnose the education needs of the patient. • Develop an education plan. • Implement a personalized education plan. • Assess effectiveness of the plan.

10. Diagnose the education needs of the patient “What does the patient need next?” • Possible education needs of patients: • To acquire new knowledge. • To learn a new skill. • To counter a negative attitude, belief or emotion. • To overcome environmental or social barriers.

11. Diagnosing an Education Need • Ask open ended questions • “Tell me what you know about asthma.” • “What should you do when you have difficultybreathing?” • “Show me how you use your inhaler.” http://www.youtube.com/watch?v=dMAS2S51bM8

12. Health Literacy According to the National Assessment of Adult Literacy: • Only 12% of adults have Proficient health literacy.  • 9 out of 10 adults may lack the skills needed to manage their health and prevent disease.  • 14% of adults (30 million people) have Below Basic health literacy. 

13. Health Literacy Excerpts from "Health literacy and patient safety: Help patients understand“ by AMA. At http://www.youtube.com/watch?v=cGtTZ_vxjyA

14. Asking Questions to Assess Knowledge Gaps http://www.youtube.com/watch?v=7_VNSGB7pgo

15. Patient’s Education Needs • In video… • What was the main factor in patient’s data that identified a problem? • What were the patient’s misconceptions? • How were these needs determined?

16. Address Knowledge Deficit • Relate new information to existing information. • Use analogies. • Be brief • Use language understandable to patient. • Use simple printed materials (5th grade literacy level). Analogy: drawing a comparison in order to show a similarity

17. Address Knowledge Deficit • Use audiovisual aids, including diagrams. • Ask and encourage questions. • Summarize key points. Analogy: drawing a comparison in order to show a similarity

18. Avoid Medical Terminology • “According to your IADL, PPS and MMSE scores, you ...” Not appropriate. Only suitable for referrals, Objective part of note. • Avoid acronyms • Translate into plain common language • If no simple words work, define terms you use

19. Visual vs Verbal Reiteration • 86% of you are visual learners • You need pictures or written words to help remember and understand procedures and concepts • Patients are your students • Do more than tell patients what to do

20. Assess effectiveness • Ask questions to assess the effectiveness of an information transfer intervention: • “When your spouse asks what we talked about, what are you going to tell her?” • “Given all this information, what is it that you are going to do now?” • “Could you please tell me our plan for today so I can check my notes and make sure I didn’t forget anything?”

21. Which of the following statements will best assess a patient’s ability to carry out your instructions? • “Do you see any problem in carrying out this procedure, routine, etc.?” • “Will you have difficulty getting this medicine?” • “So, tell me in your own words what I just told you.” • “Will you have difficulty remembering to take this medicine? ” • “Do you think this treatment plan might cause you any problems at home or at work?”

22. Questioning • Avoid questions with Yes or No answers. • Ask open ended questions. • Instead of “Will you have difficulty remembering to take this medicine? ” • Ask “How do you manage your medicines?” or “What do you do to help you take your medicines at the appropriate time?”

23. Addressing Skills Training • Techniques : • Demonstrating or modeling skills. Watch a video • Practicing skills in simplified/simulated environment. • Practicing skills in a supervised, realistic environment. • Providing feedback re: performance. • Encouraging patient self-evaluation. • Follow-up to ensure mastery and maintenance of skill.

24. Assess effectiveness • Observe the patient performing a skill to assess the effectiveness of a skills acquisition intervention: • “Let me watch you drawup and give yourselfyour insulin.”

25. Group Visits – Old idea, good results • Patients with common chronic illnesses • Address patient education needs – share ideas, experiences, etc. • Support patient self-management • Improved standards of care • Increased quality of life • Cost effective – billed as nursing visit Brennan, J, et al. Group visits and chronic disease management in adults: a review. American Journal of Lifestyle Medicine. 2011. 5;69.

26. Using Technology to Support Patient Education Caution: Digital Divide creates disparity

27. Handouts Sample Ferri’s Netter handout from MDConsult

28. Why Handouts? • Memory (Memory Test) • Anxiety • Hearing • Demand management • Communication • Complexity

29. Characteristics of Good Handouts • To conduct your own quick assessment of readability a handout, look for: • one or two syllables per word • one idea per sentence • one concept per paragraph • no more than five key points per handout • No medical terminology --should be avoided whenever possible • One or two pages at most

30. How to Use Handout • Sit next to patient • Review with patient • Provide pen/marker • Point with finger to items • Communicate priorities (most important point) • Check for understanding (health literacy and reading literacy) ADA Recommendations for Diabetic Educators

31. Websites for Patient Ed

32. Why Use Websites • Same reasons as handouts • Can be used during encounter to illustrate concepts, provide visuals • Added value: • Animations • Videos • Audio • Continued self education post encounter

33. Example: MedlinePlus from NLM • Patient Education Institute interactive videos • Adam anatomy animations • Surgical videos from OR-Live.

34. Patients Do Use the Internet • According to Pew, 80% of internet users (79% adults) or 59% adults look for health information online • The quality, reliability, applicability to patient varies widely • Guide the 59% who do to best sites – else give handout • Adults with chronic disease less likely than healthy adults to have access to the internet “Health Topics" (Pew Internet Project: February 2011). Available at: http://www.pewinternet.org/Reports/2011/HealthTopics.aspx

35. Considerations • Open access to internet in office (hospitals are notorious for blocking internet access) • Place set up so patient can see the computer screen easily • Hearing of patient –headphones handy? • Vision of patient – big screens • Access to internet by patient at home

36. Example: Youtube.com Patient Ed Animations. Posted by FSUCoM. https://www.youtube.com/user/FSUMedMedia

37. Ideas • Build lists of links for clinic patient population • Channels in YouTube (ask if patient has a computer at home, internet connection, speakers,…) • Email links to patients with questions or for further explanation

38. Finding Reliable Information Teach patients to evaluate information found on web • Where did the information come from? • Who wrote it? Is it opinion or fact? • How current is the information? • Who is responsible for the content? • Helpful Handout at Familydoctor.org http://familydoctor.org/familydoctor/en/healthcare-management/self-care/health-information-on-the-web-finding-reliable-information.html

39. Mobile Apps for Patient Ed

40. Using Mobile Apps with Patients • Larger screen devices better than smartphones • Interactive anatomical illustrations that can be emailed to patient instead of models • Animations of conditions, like asthma, murmurs • Video demonstrations of skills at fingertips

41. Prescribing Mobile Apps • If the patient has a smartphone or tablet, recommend apps for: • Medical reference • Health and fitness • Personal health record • Medical social media • Monitor and manage illness What apps are you using for your own healthor fitness?

42. Assessing Quality and Usefulness • iTunes does not discriminate medical apps into categories • Hundreds of apps for patients vs healthcare professionals - Search ‘diabetes’ get 600 apps • Check Dx organizations for reviewed apps • New effort to curate med apps like HON code, http://www.happtique.com/ • New www.medicalappjournal.com reviews Peck, Andrea. A solution to app overload. Medical Economics. Dec 25, 2011.

43. Keeping up with Medical Apps iMedicalApps.com

44. Mobile Apps for Patient Education See Handout

45. DrawMD Demo http://www.youtube.com/watch?v=OcV2A85tln0

46. As Mobile Apps Mature • Learn from your patients • Learn from peers • Ask what apps they find helpful • Include mobile apps recommendations into CME sessions on disease topics • Watch for more efforts to curate medical apps

47. Social Media as Patient Ed

48. Patient Medical Use of SM • #HCSM is the new word-of-mouth • Find a local doctor, read and write reviews of doctors • http://vitals.com • http://yelp.com • Find health information - 80% of internet users gather health information online (Pew) • Find support groups for chronic disease, health issues

49. Social Media and Informal Support Groups • Chronic Disease support groups • Awareness, support, education • Community of bloggers • Lifestyle and health maintenance support • Diet plans, track exercise… • Caregiver social support groups • Caregivers for elderly, family members with chronic disease

50. Martin Wood on Social Media Martin Wood, Assistant Director of the Maguire Medical Library http://www.youtube.com/watch?v=BnKqco8G7t4&feature=plcp